OBJECTIVES: This study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy. METHODS: A total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Paired t test was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed. RESULTS: The incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0.05). The effective reduction rate of disc was 96.77% (30/31). The quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28). CONCLUSIONS Modified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.
Humans ; Temporomandibular Joint Disc/surgery* ; Quality of Life ; Joint Dislocations/surgery* ; Temporomandibular Joint Disorders/surgery* ; Magnetic Resonance Imaging/methods* ; Temporomandibular Joint/pathology* ; Mandibular Condyle

Objective: To explore the correlation between the attachment type of lateral pterygoid muscle (LPM) and the position of temporomandibular joint (TMJ) disc in patients with temporomandibular disorders (TMD) by using wireless amplified magnetic resonance imaging detector (WAND) coupled with conventional head and neck joint coil for high resolution imaging of TMJ. Methods: Eighty-five patients with TMD diagnosed by oral and maxillofacial surgeons of Guizhou Provincial People's Hospital from October 2019 to January 2022 were collected. A total of 160 TMJ were included. There were 16 males and 69 females, aged (32.7±14.2) years. All patients were scanned with open, closed oblique sagittal and coronal WAND coupled head and neck coils with bilateral TMJ. Based on TMJ and LPM high resolution imaging, to explore the correlation between LPM attachment types and the position of TMJ disc in TMD patients, and to evaluate the potential clinical value of LPM attachment types in TMD patients. χ² test and Pearson correlation analysis were used to evaluate the correlation between LPM attachment type and TMJ disc location. Results: There were three types of LPM attachment: type Ⅰ in 51 cases [31.9% (51/160)], type Ⅱ in 77 cases [48.1% (77/160)] and type Ⅲ in 32 cases [20.0% (32/160)]. There was a significant correlation between the type of LPM attachment and the position of articular disc (χ²=28.20, P=0.002, r=0.776). There was no statistical significance between the type of LPM attachment and the reversible displacement of articular disc (χ²=0.24, P=0.887, r=0.825). Conclusions: There is a correlation between the attachment type of LPM and the position of the disc in TMD patients. WNAD coupled with conventional head and neck joint coil TMJ high resolution scan can provide reliable imaging evidence for TMD patients in evaluating the type of LPM attachment and the location of disc.
Male ; Female ; Humans ; Temporomandibular Joint Disc/pathology* ; Pterygoid Muscles/pathology* ; Joint Dislocations ; Temporomandibular Joint Disorders/diagnostic imaging* ; Magnetic Resonance Imaging/methods* ; Temporomandibular Joint/pathology*

Acromioclavicular Joint/pathology* ; Humans ; Joint Dislocations/pathology*

Traumatic anterior dislocation of the shoulder is one of the most common directions of instability following a traumatic event. Although the incidence of shoulder dislocation is similar between young and elderly patients, most studies have traditionally focused on young patients due to relatively high rates of recurrent dislocations in this population. However, shoulder dislocations in older patients also require careful evaluation and treatment selection because they can lead to persistent pain and disability due to rotator cuff tears and nerve injuries. This article provides an overview of the nature and pathology of acute primary anterior shoulder dislocation, widely accepted management modalities, and differences in treatment for young and elderly patients.
Aged ; Dislocations ; Humans ; Incidence ; Pathology ; Rotator Cuff ; Shoulder Dislocation ; Shoulder Joint ; Shoulder ; Tears

OBJECTIVEThis study aims to evaluate the effectiveness of arthrocentesis on Wilkes III stage patients. Clinical examinations and magnetic resonance imaging (MRI) findings before treatment and six months after treatment were compared and analyzed.

METHODSA total of 137 outpatients diagnosed with temporomandibular joint internal derangement (TMJID) associated with Wilkes III stage through clinical examination and MRI findings from January 2013 to December 2013 were randomly included. All the patients were successfully treated with arthrocentesis. Moreover, all the patients accepted clinical and MRI examination before arthrocentesis treatment and six months after. Clinical examination included visual analogue scale and opening degree, whereas MRI examination included articular disc morphology and effusion in the upper compartments. Statistical analysis was performed using SPSS 20.0.

RESULTSResults showed that the average score of visual analogue scale six months after treatment was significantly lower than that before treatment (P < 0.05). The success rate was 78.1% (107/137). The rate of disc deformity after arthrocentesis treatment was higher than that before the treatment. By contrast, the positive rate of effusion after arthrocentesis was significantly lower than that before the treatment (P < 0.05). Bilaminar zone adaptive changes (disk-like) were found in seven cases (5.1%, 7/137) after treatment.

CONCLUSIONArthrocentesis could effectively relieve pain of the TMJID patients. Furthermore, MRI results indicated that arthrocentesis could significantly decrease articular effusion. Arthrocentesis was effective for the treatment of Wilkes III stage in the short term. Adaptive changes in bilaminar zone occurred in a few patients. However, serious disc deformity with the passage of time is a trend that has been observed.

Arthrocentesis ; Humans ; Joint Dislocations ; Magnetic Resonance Imaging ; Outpatients ; Range of Motion, Articular ; Temporomandibular Joint Disc ; pathology ; surgery ; Temporomandibular Joint Disorders ; diagnosis ; surgery ; Treatment Outcome ; Visual Analog Scale

Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.
Accidents, Traffic ; Elbow Joint ; injuries ; Hip Dislocation ; complications ; pathology ; Humans ; Joint Dislocations ; complications ; Male ; Soft Tissue Injuries ; complications ; Young Adult

Finger Joint ; diagnostic imaging ; pathology ; Humans ; Joint Dislocations ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Radiography

PURPOSE: Displaced medial humeral epicondyle fractures with or without elbow dislocation have been treated with open reduction and fixation using K-wires or screws. The purpose of this study is to evaluate the clinical and radiological outcomes of surgical treatments of medial humeral epicondyle fracture without elbow dislocation according to the fixation methods. MATERIALS AND METHODS: Thirty-one patients who had undergone open reduction and fixation of the displaced medial humeral epicondyle fracture without elbow dislocation were included. Group I consisted of 21 patients who underwent fixation with K-wires, and Group II comprised 10 patients who underwent fixation with cannulated screws. Immediate postoperative, final follow-up and normal anteroposterior radiographs were compared and the clinical outcome was assessed using the final Japanese Orthopaedic Association (JOA) elbow assessment score. RESULTS: On the immediate postoperative radiographs, the distal humeral width in Group II was larger than that in Group I. On the final follow-up radiographs, the epicondylar position in Group I was lower than that in Group II. There was no significant difference in the distal humeral width, epicondylar position and joint space tilt between the immediate postoperative, final follow-up radiographs and the normal side within each group. There was no significant difference in the final JOA score between groups. CONCLUSION: Open reduction followed by K-wire fixation or screw fixation of the displaced medial humeral epicondyle fracture without elbow dislocation in older children and adolescents resulted in improved radiologic outcome and good elbow function in spite of diverse radiologic deformities.
Adolescent ; Bone Screws ; Bone Wires ; Child ; Dislocations/*prevention & control ; Elbow Joint/*pathology ; Female ; Humans ; Humeral Fractures/*surgery ; Male

OBJECTIVETo summarize the techniques and evaluate the therapeutic effect of posterior fixation and fusion in the treatment of Os odontoideum complicated by atlantoaxial dislocation.

METHODSFrom March, 2007 to October, 2010, 10 patients with Os odontoideum (including 6 male and 4 female patients aged from 20 to 65 years, mean 39.8 years) were treated in our hospital. Before and after the operation, the patients underwent X ray, CT and MRI examinations to measure and evaluate the degree of dislocation and neural compression. After preoperative traction for 1-2 weeks, all the 10 patients showed deductible atlantoaxial dislocation. Through a posterior approach, Atlantoaxial pedicle screws fixation were performed in 9 cases, and C2/3 pedicle-Occiput screw fixation was performed in 1 case. All the patients wore cervical collars as external support for 3 months after the operation.

RESULTSThe mean operative time was 3 h in these patients with a mean intraoperative blood loss of 420 ml. The symptoms were relieved after the surgery in all the patients, who showed no neck pain or neurological defects. The patients were followed up for 6 to 52 months (mean 22 months), and bony fusion was observed in all the 10 cases within 6 to 8 months without such complications as internal fixation failure or redislocation of the atlas.

CONCLUSIONPatients with Os odontoideum complicated by atlantoaxial dislocation should undergo surgical stabilization to avoid severe neurological injury. Pedicle screw instrument in the atlas allows restoration of the spinal stability, short-segment fusion, and maximal preservation of the mobility of the neck.

Adult ; Aged ; Atlanto-Axial Joint ; injuries ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; complications ; surgery ; Joint Loose Bodies ; complications ; surgery ; Male ; Middle Aged ; Odontoid Process ; pathology ; Spinal Fusion ; methods ; Treatment Outcome ; Young Adult

OBJECTIVETo study the rotary angle and image features, so as to help early diagnosis.

METHODSFour adult cervical spine (C1-T1) specimens were used, including 2 males and 2 females,ranging in age from 28 to 40 years old. X-ray and CT examination were performed before the experiment. C2-C4 and C5-T1 were fixed respectively using self-made clamp. Unilateral locked facet of cervical spine was simulated under the violence of inflection and rotation, in which the muscle contraction was partially simulated, and at last the plain radiographs and CT of unilateral locked facet of cervical spine were analyzed.

RESULTSIn unilateral locked facet of cervical spine, the average rotary angle was 19.75 degrees, and average forward shift of vertebral was 3.68 mm. The intervertebral foramina below the injury plane were showed at 0 degrees,10 degrees, 180 degrees,190 degrees; the intervertebral foramina above the injury plane were showed at 150 degrees,160 degrees, 00 degrees, -10 degrees, and the facet was locked or in disorder at the injury plane. The intervertebral foramina at the anterior oblique position was bigger in interlocking side, but it was smaller in the opposite side. CT scan showed rotary spine, the naked facet sign; coronal plane reconstruction showed bilateral asymmetry; sagittal plane reconstruction obviously showed unilateral locked facet.

CONCLUSIONX-ray and CT both can independently diagnose unilateral locked facet of cervical spine. CT and three-dimensional reconstruction are more better than X-ray to diagnosing it.

Adult ; Cervical Vertebrae ; diagnostic imaging ; injuries ; pathology ; Female ; Humans ; Joint Dislocations ; diagnostic imaging ; Male ; Rotation ; Tomography, X-Ray Computed ; methods